BACKGROUND AND IMPORTANCE: In the Czech Republic, paramedics are required to consult a physician before administering intravenous opioids, which may delay effective prehospital pain management. As paramedic competencies expand in Europe, it is important to evaluate the safety and efficacy of independent opioid administration in prehospital emergency care settings. OBJECTIVES: To assess the safety and effectiveness of intravenous sufentanil administered independently by trained paramedics compared to administration following remote physician consultation in adult trauma patients. DESIGN: Prospective, single-center, observational cohort study. SETTINGS AND PARTICIPANTS: Conducted at the Emergency Medical Services of the Karlovy Vary Region between January 1 and December 31, 2024. The study included 462 adult trauma patients who were hemodynamically stable and conscious. Patients were divided into two groups: the Consultation group (physician consultation required) and the Competency group (paramedics administering independently). INTERVENTION OR EXPOSURE: Intravenous administration of sufentanil, with or without physician phone consultation. OUTCOME MEASURES AND ANALYSIS: Primary outcomes included reduction in pain (measured using the Numeric Rating Scale, NRS) and incidence of adverse events (e.g., respiratory depression, oxygen desaturation, hypotension, and antiemetic use). Statistical significance was set at p < 0.05. MAIN RESULTS: Both groups achieved similar pain reduction. The Competency group received a higher mean dose of sufentanil (9.7 ± 3.0 μg vs. 8.9 ± 2.8 μg; p = 0.006) and more frequently used non-opioid adjuvant analgesics (54% vs. 41%). Documentation of pain scores was significantly better in the Competency group (87% vs. 43%; p < 0.01). Adverse events were rare, non-serious, and comparable between groups. Antiemetics were more frequently administered in the Competency group (11% vs. 6%; p = 0.037). A minor, clinically insignificant reduction in diastolic blood pressure was observed in the Competency group. CONCLUSION: Intravenous sufentanil administered independently by trained paramedics in adult patients with lower severity trauma demonstrated safety and effectiveness comparable to administration following remote physician consultation, along with improved documentation and increased use of multimodal analgesia. Although this was a monocentric study, these observations may contribute to ongoing discussions about expanding paramedic competencies in opioid analgesia within the Czech prehospital emergency system.

Department of Anesthesia and Intensive Care 3rd Faculty of Medicine Charles University and FNKV University Hospital Prague Czech Republic

Emergency Medical Services of Karlovy Vary Region Zavodni 390 98C Karlovy Vary 36006 Czech Republic

Medical College Prague Czech Republic

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